Replacing heparin with rtPA in dialysis catheters once a week may reduce the incidence of catheter malfunctions and infections. rt–PA is normally used to break up stroke–causing clots in the brain. However, when researchers used this drug in dialysis catheters instead of heparin after one of three dialysis sessions a week, the rate of catheter malfunction dropped from 35% to 20%. In addition, the infection rate was 4.5% in the group that received rt–PA compared to 13% for the group treated only with heparin.

rt–PA reduces the rates of catheter malfunction by about 50% and infections by almost two–thirds reports the study published in the Jan. 27 issue of the New England Journal of Medicine.

Revisiting the year 2010 with Dr KK Aggarwal
New pill for HIV prevention

Quote of the Day

I offer you peace. I offer you love. I offer you friendship. I see your beauty. I hear your need. I feel your feelings My wisdom flows from the Highest Source. I salute that Source in you. Let us work together for unity and love. Mahatma Gandhi

Indira Gandhi National Open University’s National Centre for Disability Studies in collaboration with the Rehabilitation Council of India is inviting applications for its special certified training programme for school teachers, "Foundation course on education of children with disabilities" for its February batch. The course offers distance education programmes in Hindi and English and will also be available soon in Bengali, Malayalam, Tamil, Oriya and other mediums. Practical training will be imparted to students at RCI-recognised study centres under the guidance of qualified resource teachers. State sponsorship is available for Sarva Shiksha Abhiyan teachers. (Source: The Hindu, Jan 27, 2011)

The cost of treating heart disease in the United States will triple by 2030, according to new projections from the American Heart Association. The $545 billion increase is due in part to an aging population. The skyrocketing financial burden makes it urgent to implement effective strategies to prevent heart disease and stroke. "Despite the successes in reducing and treating heart disease over the last half century, even if we just maintain our current rates, we will have an enormous financial burden on top of the disease itself," said Paul Heidenreich, M.D., chair of the American Heart Association expert panel issuing the statement. The panel estimated future medical costs based on the current rates of disease and used Census data to adjust for anticipated population shifts in age and race. The rigorous methods they devised didn’t double count costs for patients with multiple heart conditions.

"These estimates don’t assume that we will continue to make new discoveries to reduce heart disease," Heidenreich said. "If our ability to prevent and treat heart disease stays where we are right now, costs will triple in 20 years just through demographic changes in the population." The panel said effective prevention strategies are needed to limit the growing burden of cardiovascular disease — the leading cause of death in the United States that accounts for 17 percent of overall national health expenditures. "Unhealthy behaviors and unhealthy environments have contributed to a tidal wave of risk factors among many Americans," said Nancy Brown, American Heart Association CEO. "Early intervention and evidence–based public policies are absolute musts to significantly reduce alarming rates of obesity, hypertension, tobacco use and cholesterol levels."

Currently, 1 in 3 Americans (36.9 percent) have some form of heart disease, including high blood pressure, coronary heart disease, heart failure, stroke and other conditions. By 2030, approximately 116 million people in the United States (40.5 percent) will have some form of cardiovascular disease, the panel said. The largest increases are anticipated in stroke (up 24.9 percent) and heart failure (up 25 percent). Between 2010–30, the cost of medical care for heart disease (in 2008 dollar values) will rise from $273 billion to $818 billion, the authors predicted. "We were all surprised at the remarkable increase in costs that are expected in the next two decades," Heidenreich said. "We need to continue to invest resources in the prevention of disease, the treatment of risk factors and early treatment of existing disease to reduce that burden." Heart disease will also cost the nation billions more in lost productivity, increasing from an estimated $172 billion in 2010 to $276 billion in 2030. Productivity losses include days missed from home or work tasks because of illness and potential lost earnings due to premature death.

(Dr Monica and Brahm Vasudev)

Indian doctor’s book on cancer in US award shortlist

New York–based physician Siddhartha Mukherjee’s biography of cancer –– " The Emperor of All Maladies" –– has been shortlisted in the non–fiction category for US’ prestigious National Book Critics Circle Award 2010. The National Book Critics Circle Award is an annual award given in six categories –– fiction, non–fiction, autobiography, biography, criticism, and poetry, to promote the finest books and reviews published in English. The winners will be announced on March 10. In "The Emperor of All Maladies", published by HarperCollins India, the researcher and award winning science writer examines cancer with a cellular biologist’s precision, a historian’s perspective, and a biographer’s passion. (Source: The Times of India, Jan 27, 2011)

Smoking, obesity have cut three to four years from increasing US life expectancy

Smoking, a declining habit, and obesity, a burgeoning problem, have cut three to four years off the increasing life expectancy of Americans, an international longevity comparison concludes. (National Research Council report)

According to a study published in the journal Diabetes Care, exposure to metformin is associated with a reduced risk for cancer in patients with type 2 diabetes.

Silent myocardial ischemia may be more common in asymptomatic type 2 diabetics than nondiabetics

According to a study published Jan. 21 in the journal Cardiovascular Diabetology, true silent myocardial ischemia is significantly more common in asymptomatic type 2 diabetics than nondiabetics.

Traffic noise may increase stroke risk in older individuals

Many people who live in cities or near highways are accustomed to a lullaby of cars whizzing by, but that noise may put them at increased risk of stroke, according to a study published in the European Heart Journal.

Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

How many people are affected by infertility?

Estimates are that one in six couples is affected by some measure of infertility. However, that number may be very deceptive. Many couples choose to lead child–free lives rather than look for treatment for their infertility, and we believe they are rarely included in infertility estimates. Others suffer frequent pregnancy losses which are, in a way, a form of infertility and are not technically considered "infertile" because they are able to conceive. INCIID is in the process of creating a survey designed to provide new insights about who is infertile, what kinds of infertility they are experiencing, what kinds of treatments have been successful for specific diagnoses, and much more. This survey will be conducted online, and is expected to be a source of important clinical information for practitioners as well as consumers.

The hepatitis C virus is spread primarily by exposure to blood. People may get hepatitis C by sharing needles to inject drugs, through exposure to blood in the workplace, from unsterile equipment used for body piercing, tattoos or acupuncture, exposure to dental or medical practices with poor infection control practices or by sharing personal care items including nail clippers, razors, scissors with infected people. The risk of getting this virus from a blood transfusion is minimal but still exists. All donated blood is now screened for the hepatitis C virus.

Hepatitis C has been transmitted between sex partners and among household members. However, the degree of this risk still needs to be accurately defined. An infected mother can pass HCV to her child at birth.

There is no evidence that hepatitis C virus is spread by casual contact. Sneezing, coughing and hugging do not pose the risk for hepatitis C. In addition, there is no evidence that hepatitis C virus is spread by food or water.

The proposed measure which seeks to liberalize certain existing provisions relating to the termination of pregnancy has been conceived

As a Health measure – when there is danger to the life or risk to the physical or mental health of the women;

On humanitarian grounds – such as when pregnancy arises from a sex crime like rape or intercourse with a lunatic women, etc.;

Eugenic grounds – where there is a substantial risk that the child, if born, would suffer from deformities and diseases.

The Bill was passed by both Houses of the Parliament and got the President’s assent on 10–8–1971. The Act has recently been amended by the The Medical Termination of Pregnancy (Amendment Act), 2002.

Legal Question of the Day

(Contributed by Dr MC Gupta, Advocate)

Q. The government of Uttar Pradesh has not granted permission for doing autopsies in government medical colleges while the autopsies are routinely being carried out by MBBS doctors employed in the Provincial Medical Service in UP. What should be done?

Ans.

This is unusual. There must be some reason. It is for the medical college faculty to find the reason.

Performing an autopsy for the police is work done for the police. Redressal of a wrong can be asked only when a wrong has been done or a right has been denied. Medical college faculty cannot demand work from the police department.

The government medical college faculty has a right to demand autopsy work if as per the terms and conditions of service, the job of the faculty involves performing, supervising and teaching how to do autopsies. It is a right of the faculty to demand autopsy work for which it was employed. To secure this right, the faculty should send a proper legally drafted representation to the government, on the basis of which a writ petition may be filed if the government does not act.

The above representation/writ petition should be so drafted as to include the MCI as a party because it is the MCI which inspects medical colleges and grants them recognition.

A study concluded that children receiving live attenuated influenza vaccine (LAIV) had a high level of protection against influenza–associated acute otitis media when compared with placebo or TIV. This was most evident in children older than 2 years, for whom LAIV is indicated. LAIV recipients who contracted breakthrough influenza illness despite vaccination developed AOM at a significantly lower rate than did unvaccinated children who developed influenza.

Situation: A patient came with 10–second episodes of chest pain. Dr. Bad: It is classical angina. Dr. Good: It is non–cardiac chest pain. Lesson: Cardiac pain is never less than 30 seconds.

Make Sure

Situation: A patient with diabetes shows deteriorating kidney function. Reaction: Oh my God! His HbAIc is very high? Lesson: Make sure that strict glycemic control is maintained in patients with type 2 diabetes in order to delay vascular complications.

Lighter Side of Reading

An Inspirational Story (Contributed by Dr Prachi Garg)

Migrating Geese

The next season, when you see the geese migrating, going to a warmer place, to sort the winter…

Pay attention that they fly in a "V" formation. Maybe you will be interested in knowing why they do it this way.

By flying in a "V" formation…The whole flock increases the flight efficiency by 71% compared to just one bird flying alone.

In a plane that’s about to crash, there are three passengers: the wisest man on earth, a student, and a politician. When they find out that the plane is about to go down and there is only one parachute between the three of them they debate about who would sacrifice his life for the country and who will jump to safety.

The politician says he’s responsible for running the country, so of course, he should be the one to jump. The wise man says he's got to serve mankind, so he should be the one who jumps. The student says he is the future, and he should be the recipient of the parachute. As the kid speaks, the wise man grabs the bag and leaps wildly out of the plane. The politician is astounded, but the student remains calm. "Why are you so calm? We’re both about to die!" exclaims the politician.

The student replies, "Well wisdom just leapt out with my school bag, so the future can hang on to politics and feel safe."

— — — — — — — — — —

Knowledge is amusing

FORTNIGHT comes from ‘Fourteen Nights’ (Two Weeks)

Readers Responses

Letter to Editor

Can Dentists Advertize?
In mid October 2010, about ten dentists in Kanyakumari District received an intimidating notice from the Tamilnadu State Dental Council (TNSDC) threatening to take action for placing an advertisement in the local daily. The TNSDC was apparently acting on a complaint made by a former President of the TNSDC. This is not the first time that the TNSDC has pulled up private practitioners and I do not think it will be the last time. In fact I will not blame the council who are just doing their job. The real problem is with some busy bodies who like to exert their power and position by harassing poor dentists with an outdated regulation (1976) which should have been dumped ages ago. Why does the TNSDC act against only some dentists when so many powerful dentists blatantly advertize and have outsized boards? Many of them advertize brazenly in the print and electronic media on a regular basis in the name of providing public information. Everybody knows that this is surrogate advertising that aims at drawing attention to themselves and their ‘great’ achievements. Three years ago another ‘gentleman’ dentist who was and continues to be the secretary of a Chennai IDA branch used his position to file a complaint against several dentists in Chennai. This ‘guardian of medical ethics’ made many of the dentists withdraw their ‘large boards’ and submit a letter of apology to the Council. Should highly qualified dentists be subject to such indignities on a selective basis? Well! One of the dentists, Dr S Murukesan, did not think so and went to court. The TNSDC and the DCI accused him guilty of violation of the code of ethics because he had a board larger than the stipulated 3ftX2ft and because he called his clinic a craniofacial centre (Dr Murukesan has trained as a cleft and craniofacial orthodontist in Taiwan on an international fellowship). It also happens that Dr Murukesan practices just opposite the clinic of the person who made the complaint. After a prolonged and costly legal battle the Madras High Court granted a stay on the administrative proceedings of the TNSDC and DCI. This verdict was in favour of Dr Murukesan. Much money was spent by the two councils to ‘teach’ the dissenting ‘violator’ a lesson. It is not a big deal for TNSDC and DCI because the money spent on legal fees was public money. Dr Murukesan on the other hand had to spend money from his pocket. But then he had the determination, courage and sense of fairness to spend his hard earned money rather than bend before badly used archaic laws to selectively target individual dentists like you and me. In his affidavit, Dr Murukesan had stated that the complainant made the accusation driven by professional rivalry. When almost all dentists (including me) have sign boards larger than the stipulated size, why were only Dr Murukesan and a few others targeted?? There are dentists who call their establishments as Craniofacial Hospitals and remain untouched by the regulatory body. Is it because the TNSDC is afraid of them and their political clout? Hundreds of Dentists advertize in the Yellow pages. Numerous dentists advertize on their websites which has been accepted as public electronic media by the Government. Hundreds indicate their clinic on Google maps when the Dentist Act prohibits a sign board except in their place of practice. The 1976 Code of Ethics was established 37 years ago, before the advent of the Internet and the e mail. It is high time the dentists of the country rise up as one and fight these unfair rules and codes that allow multinationals and corporate firms to advertize indiscriminately while targeting individual dentists who are struggling to make a living. This is meant to give an unfair advantage to corporate dental clinics while small time private dental clinics will be wiped out by an unequal playing field. A newly launched corporate dental group which advertizes indiscriminately even on road dividers along with restaurants and mobile services, is in fact headed by the former vice President of the DCI. What happened to ethics? These corporates too are providing dental care after all!!

It is important to mention that countries like the UK, USA, European Community and countries all over the world have done away with these unreasonable rules and laws that unreasonably restrict dentists in the name of ethics. The Monopolies and Mergers Commission in the UK has allowed all doctors to advertise in the best interest of the public. Similarly the Trade and Monopolies commission has allowed Doctors and Dentists to advertize freely as long as the matter is factual and correct. The Consumer Protection Act has clearly defined medical service in India as commercial service. Dr Sanjay Pandey in the Journal of The Indian Society of Medical Ethics asks why they should not be allowed to advertize like all commercial establishments as long as it is factual and correct?

It is high time that the IDA takes up this matter in the interest of the individual dentist, rather than allow some of its office bearers to use their official position and letter head to target fellow dentists in the name of ethics. For further details contact:Dr George Paul. E Mail: maxfaxgp@gmail.com, Dr S. Murukesan. E Mail: smurukesan@craniofacialclinic.in

Public Forum

(Press Release for use by the newspapers)

White sugar as addicting as heroin and cocaine

White sugar is addictive and the number one cause of heart disease, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

The sweetener prompts the same chemical changes in the brain seen in people who abuse drugs such as cocaine and heroin.

Quoting a study presented at the American College of Neuro–Psychopharmacology’s annual meeting, Dr Aggarwal said that evidence from an animal model suggests that bingeing (drinking large amounts of sugar water) when hungry can cause behavioral changes and even neurochemical changes in the brain which resemble changes that are produced when animals or people take substances of abuse. These animals show signs of withdrawal and even long-lasting effects that might resemble craving.

In the study, rats were denied food for 12 hours a day, and then were given access to food and sugar (25 percent glucose and 10 percent sucrose) for 12 hours a day, for three to four weeks. The chemical involved in addiction in the body is dopamine.

A "sugar addiction" may even act as a "gateway" to later abuse of drugs such as alcohol. The stages of addiction, as defined by the American Psychiatric Association, include bingeing, withdrawal and craving.

White sugar, white rice, and white maida (refined flour), the triad of refined carbohydrates are all addicting and related to insulin resistance, obesity and heart disease.